Vagal nerve schwannoma (large)

Case contributed by Dr Ian Bickle

Presentation

Right sided neck lump for 2 years. Increased in size of late. Wasting of the right side of the tongue, consistent with a 12th nerve palsy.

Patient Data

Age: 40 years
Gender: Female
CT

CT NECK

5.6 x 3.2cm well defined minimally enhancing mass centered on the right carotid space and extending into the parapharyngeal space.

The mass extends inferior to the carotid bifurcation with the internal and external carotid arteries both anteriorly displaced lying on the anterior surface of the mass. The upper limit of the mass is at the jugular foramen.

No skull base or mandibular destruction, erosion or hyperostosis.

No cervical lymphadenopathy.

Comment: Right carotid space mass in keeping with biopsy proven schwannoma. No bony destruction.

MRI

6.7 x 5.6cm well defined T2 and FLAIR hyper intense mass centered on the right carotid space extending from the carotid bifurcation to the skull base. The mass has displaced the ICA anteromedially and splayed the external carotid laterally. No evidence of encasement.

The lesion is isointense on T1 with intense heterogenous enhancement.

The nasopharyngeal space is normal.  Right parotid and submandibular glands are normal.

No evidence of any cervical lymphadenopathy. 

Case Discussion

This case is a large carotid space-based mass with displacement of the carotid bifurcation.

The MRI signal characteristics and enhancement pattern were most suggestive of a schwannoma.  The centring on carotid space would indicate it is vagal (CN 10) nerve-derived, however clinically the patient has a hypoglossal (CN 12) palsy.

At surgery the explaination was evident - the hypoglossal nerve was tightly stretched over the lateral aspect of the mass.

PlayAdd to Share

Case information

rID: 59561
Published: 14th Apr 2018
Last edited: 14th Mar 2019
System: Head & Neck
Tag: ripas2
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.